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An isolated elevation of glutarylcarnitine (C5-DC) in plasma or newborn screening blood spots is related to a diagnosis of glutaric aciduria type 1 (GA-1), also known as glutaric acidemia type 1. GA-1 is caused by a deficiency of glutaryl-CoA dehydrogenase. Follow-up testing is necessary for confirmation. Urinary excretion of C5-DC is a specific biochemical marker of GA-1 that appears to be elevated even in low excretors, affected patients with normal levels of glutaric acid in urine.
GA-1 is characterized by bilateral striatal brain injury leading to dystonia, often a result of acute neurologic crises triggered by illness. Many affected individuals also have macrocephaly. Dietary treatment and aggressive interventions during time of illness are recommended to try to prevent or minimize neurologic injury, which is most likely to occur in infancy and early childhood. Prevalence is approximately 1 in 100,000 individuals.
The American College of Medical Genetics (ACMG) newborn screening work group published diagnostic algorithms for the follow-up of infants who had a positive newborn screening result. For more information, see URL: http://www.acmg.net.
Evaluation of patients with an abnormal newborn screen showing elevations of C5-DC
Diagnosis of glutaric aciduria type 1 deficiency
Elevated excretion of C5-DC is a specific biochemical marker of glutaric aciduria type 1 that is elevated in affected patients, apparently even in low excretors or those affected individuals with normal levels of glutaric acid in urine.
The results of urine acylcarnitines are not informative when the patient is receiving L-carnitine supplements.
<1.54 millimoles/mole creatinine
1. Tortorelli S, Hahn SH, Cowan TM, et al: The urinary excretion of glutarylcarnitine is an informative tool in the biochemical diagnosis of glutaric acidemia type I. Mol Genet Metab 2005;84:137-143
2. Kolker S, Christensen E, Leonar JV, et al: Diagnosis and management of glutaric aciduria type I-revised recommendations. J Inherit Metab Dis 2011:34:677-694